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Item G2 BOARD OF GOVERNORS—FIRE AND AMBULANCE DISTRICT 1 AGENDA ITEM SUMMARY Meeting Date: February 19, 2014 Division: Emergency Services Bulk Item: Yes X No Department: Fire Rescue Staff Contact Person: Holly Pfiester 289-6088 AGENDA ITEM WORDING: Approval of a renewal option, for a one (1) year term effective March 1, 2014 through February 28, 2015, to the current agreement between the Board of Governors and Roy Khanna (individual) for the maintenance on all Monroe County Fire Rescue ambulances and other vehicles, including quarterly inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure; Monroe County Fire Rescue acknowledges this is the only renewal option on the current agreement, and a Request for Proposals (RFP) must be issued resulting in a new contract signed for next year. ITEM BACKGROUND: On February 16, 2011, the Board approved a three (3) year agreement effective March 1, 2011 through February 28, 2014, with one renewal option, for a one (1)year term pursuant to section B, page one (1). PREVIOUS RELEVANT BOG ACTION: On January 3, 2007 sealed bids were opened as a result of an RFP issued; Roy Khanna was the only bidder. On February 21, 2007, the Board approved an agreement effective March 1, 2007 through February 29, 2008 with three (3) one (1) year renewal options. On February 20, 2008, the Board approved a renewal agreement to extend the contract with Roy Khanna for the 1st one-year renewal, effective March 1„ 2008 through February 28, 2009. On February 18, 2009, the Board approved a renewal agreement to extend the contract with Roy Khanna for the 2"d one-year renewal, effective March 1, 2009 through February 28 2010. On February 17, 2010, the Board approved a renewal agreement to extend the contract with Roy Khanna for the 3rd one-year renewal, effective March 1, 2010 through February 28, 2011. On January 11, 2011 sealed bids were opened as a result of an RFP issued; Roy Khanna was the only bidder, resulting in the current agreement. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATIONS: Approval TOTAL COST FY14: $120,000 INDIRECT COST: BUDGETED: Yes X No SOURCE OF FUNDS: 13001-530462 REVENUE PRODUCING: Yes No . X AMOUNT PER MONTH Year .lx� � APPROVED BY: County Atty411/OM m/Purchasing V Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# BOARD OF GOVERNORS—FIRE AND AMBULANCE DISTRICT 1 CONTRACT SUMMARY Contract with: Roy Khanna Contract# ....................................................... ....._...........—_ (individual) Effective Date: 03/01/2014 Expiration Date: 02/28/2015 Contract Purpose/Description: Approval of a renewal option, for a one (1) year term to the current agreement between the Board of Governors and Roy Khanna(individual) for the maintenance on all Monroe County Fire Rescue ambulances and other vehicles. Contract Manager: Holly Pfiester 289-6088 Emergency Services/ Stop 14 (Name) (Ext.) (Department/Stop#) for BOG meeting on 02/19/2014 Agenda Deadline: 02/04/2014 CONTRACT COSTS Total Dollar Value of Contract: $ 120,000 Current Year Portion: $ 120,000 Budgeted FY14 Yes® No ❑ Account Codes: 13001-530462 Grant: $ County Match: $ - - - - ADDITIONAL COSTS Estimated Ongoing Costs: $ 120,000/ year For: (eg.maintenance,utilities,janitorial,salaries,etc.)""" CONTRACT REVIEW Changes Date Out Date In Needed Division Director Yes❑No g Risk Mana ement "` Yes No �. 0 Yes[:]O.M.B./Purchase .m -ng Not County Attorney (, �' �� Yes No Comments: RENEWAL AGPEEMENT This AGREEMENT dated the 19"' day of_ February ,2014,by and between the Board of Governors of Fire and Ambulance District 1 of Monroe County, Florida,hereinafter referred to as"DISTRICT"and Roy Khanna, hereinafter referred to as"CONTRACTOR" WITNESSETH: WHEREAS,the parties hereto did enter into an agreement effective March 1,2011 through February 28,2014 for the maintenance on all Monroe County Fire Rescue ambulances and other vehicles, including quarterly inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure WHEREAS, said agreement provided to the DISTRICT one renewal option, for a one (1)year term; and WHEREAS,the DISTRICT has elected to exercise said option for the continuation of the maintenance on all Monroe County Fire Rescue fire rescue ambulances and other vehicles, including quarterly inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure; now therefore IN CONSIDERATION of the mutual covenants and obligations contained herein,the parties agree as follows: 1. The DISTRICT elects to renew the contract for the one renewal option,for a one(1)year term pursuant to Section B, page 1 of the agreement entered March 1,2011. 2. A new paragraph W is added to the Agreement,to read as follows: W. Pursuant to F.S. 119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, including but not limited to: (a) Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in order to perform the service. (b) Provide the public with access to public records on the terms and conditions that Monroe County would provide the records and at a cost that does not exceed the cost provided in Florida Statutes,Chapter 119 or as otherwise provided by law. (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (d) Meet all requirements for retaining public records and transfer, at no cost,to Monroe County all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to Monroe County in a format that is compatible with the information technology systems of Monroe County. 3. The effective date of this amendment is March 1, 2014 and shall extend through February 28, 2015. Except as amended herein,all other terms and conditions of the prior Agreement remain in full force and effect. CONTRACTOR: MONROE COUNTY ATTORNEY APP VED AS TO 0 �C NTHIA LP ALL ASSISTANT C07NTY ATTORNEY By. r .....� M Date—_� Khanna Date (SEAL) BOARD OF GOVERNORS OF FIRE AND ATTEST: AY HEAVIL ,CLERK AMBULANCE DISTRICT 1 OF MONROE COUNTY,FL Ya. ...,......,..,. „., ,.,,,,,.. Deputy Clerk Mayor f Chairman Organization Code Expenditure Detail Item Budget grouped by Organization Code, Account Object Monroe County Board of County Commissioners Fiscal Year 2014 Service FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 Expenditure Detail Item Description Level Issue# Budget Budget Budget Budget Budget 13001 Lk& Mk Ambulance 530440 Rentals And Leases 13001 Lk&Mk Ambulance 530440 Rentals And Leases Notes Total Lease contract$6,596 shared by 4 cost centers $1,649 (13001) $1,649 [12000) $1,649 (12001) $1,649 R 13500) 530440 Rentals And Leases 45,297 45,297 45,297 0 0 I 13001 Lk&Mk Ambulance 45,297 45,297 45„297 0 0 530440 Rentals And Leases 45„297 45,297 46,297 0 0 530460 Repair And Maintenance t 11 Lk&Mk Ambulance 530460 Repair And Maintenance 01) Stretchers 1 5,000 5,000 5,000 0 0 Notes Historical experience 02) LifePak 15 1 23,000 23,000 23,000 0 0 Notes All Monitors and DefibriYlators - Mandated by Joint Committee Accre&tatlo-n of Hospitals(JCAH) 03) [AED] Automatic External Defibrillators 1 3,000 3,000 3,000 0 0 Notes Historical experience 04) ALS Trainer Manikins 1 2,000 2,000 2,000 0 0 Notes Replacement Parts 530460 Repair And Klatnaenan(c 33,000 33,000 33,000 0 0 I13001 Lk&Mk Ambulance 33,000 33,000 33,000 0 0 530460 Repair And Maintenance 33,000 33,000 33„000 0 0 530462 Vehicle aint 13001 Lk&Mk Ambulance 130461 Vehicle Main, 01y EMS Units(Vehicles 1 120,000 120,000 120,000 0 0 Notes Projected increase over FY13-Aging Equipment Rescue Units,USAR vehicles,etc Semi-Annual Level I Maintenance Annual Level II Maintenance Annual Pump Testing Overall Repairs 02) Tires 1 5,000 5,000 5,000 0 0 Notes Projected increase over FY13 03) Towing 1 2,500 2,500 2,500 0 0 Notes Breakdowns of Rescue Units,USAR vehicles,etc. 04) Maintenance Supplies 1 2,000 2,000 2,000 0 0 Notes. Oil,Wash&Wax,Window Washer Fluid,etc 53046 Velucle,llaint 129,500 129,500 129,500 0 0 13001 Lk&Mk Ambulance 129,500 129„600 129,600 0 0 530462 Vehicle Maint 129,500 129,500 129,500 0 0 530470 Printing And Binding 13001 Lk 8,Mk Ambulance 530470 Printing And Binding 01'p Forms,etc 1 2000. 2000, 2,000 0 0 Notes Projected increase over FY13 13001 Lk&Mk Ambulance 2„000 2,000 2,000 0 0 Gov Max V6 51 10R3F2013 10:39-31AM-ET u CONTRACT BETWEEN THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT I OF MONROE COUNTY,FLORIDA AND ROY KHANNA FOR MAINTENANCE OF FIRE RESCUE AMBULANCES and OTHER VEHICLES THIS CONTRACT, hereinafter"CONTRACT OR AGREEMENT"made and entered into this 16'h day of February,2011 by and between the Board of Governors Fire and Ambulance District I of Monroe County, Florida, hereinafter referred to as "COUNTY", and Roy Khanna,hereinafter referred to as"CONTRACTOR". WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for proposals for MAINTENANCE OF FIRE RESCUE AMBULANCES AND OTHER VEHICLES, WHEREAS,the successful Respondent was Roy Khanna,and; WHEREAS,this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an agreement for the maintenance of Monroe County Fire Rescue Type I ambulances and other vehicles which shall include inspections, preventative maintenance and unscheduled maintenance and repairs resulting from failure or malfunction with the CONTRACTOR and; WHEREAS,this contract is an"Agreement"between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: A. CONTRACT DOCUMENTS—This contract consists of the Agreement,the CONTRACTOR'S response to the RFP, the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents,the one imposing the greater burden on the CONTRACTOR will control. B. CONTRACT PERIOD AND RENEWAL-The effective date of this Agreement shall be March 1, 2011 through February 28,2014 for three (3) years. This Agreement may be renewed for a one(1)year term, subject to approval of the Fire Chief of Monroe County Fire Rescue,the Office of Management and Budget and the Monroe County Board of Governors Fire and Ambulance District 1. C. CONTRACT TERMINATION -This Agreement may be terminated for any reason by either party on 30-day written notice without cause. If the CONTRACTOR fails to fulfill the terms of this Agreement,or attachments, properly or on time, or otherwise violates the provisions of the agreement or of applicable laws or regulations governing the use of funds, the County may terminate the contract by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall, at the option of the County, become property of the County. The County shall pay the CONTRACTOR fair and equitable compensation for expenses incurred prior to termination of the agreement, less any amount or damages caused by the CONTRACTOR'S breach. If the damages are more than compensation payable,the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. D. SUBJECT MATTER OF CONTRACT-This Agreement is for performing scheduled general and preventative maintenance of approximately Ten(10)Type I ambulances, Two (2)Rehab units, One(1)MCI Truck and One(1)MCI Trailer with Monroe County Fire Rescue. This shall include inspections, preventative maintenance and unscheduled maintenance and repairs resulting from failure or malfunction. See"Attachment I" for the list of ambulances and other vehicles. The amount of ambulances and other vehicles may be added or deleted throughout the life of the contract by Monroe County Fire Rescue. E. RATES -The hourly rate shall be$75.00 per man-hour with no travel time or mileage charge. The charge for conducting an ambulance inspection with each preventative maintenance performed will be$275.00. F. OVERTIME AND HOLIDAYS -Rates per man-hour for emergency repairs called outside normal business hours and federal holidays shall be one and one half times the normal rate. G. WORK SC14EDULE- Regularly scheduled inspections and preventative maintenance shall be conducted at such intervals as are approved by the COUNTY and by the manufacturer. The modular portion of the vehicle shall also be maintained in accordance with the manufacturer's recommendations. H. PARTS, FLUIDS AND LUBRICANTS - All parts,fluids, and lubricants used for maintaining and repairing vehicles shall be supplied by CONTRACTOR and billed to the COUNTY at cost plus 25%. For parts$200.00 and over, a copy of original parts supplier invoices shall be attached to the bill. CONTRACTOR will be required to keep all original parts supplier invoices available at request by County for spot checking and auditing purposes. I. ENGINE OIL AND FILTER CHANGE and complete drive train lubrication and any other fluids and/or filter changes,shall be performed as recommended by the manufacturer. J. WEEKLY MAINTENANCE SCHEDULE- CONTRACTOR shall provide to the COUNTY a preventative maintenance schedule that can be performed weekly by the individual Fire Departments' personnel. The contractor shall provide in service training to the Lieutenants on all three shifts at all of the stations at no extra cost. This will be scheduled by the contractor with the on-duty Lieutenants and can be done during Preventative Maintenance visits. K. MAINTENANCE INVOICE and LOG-CONTRACTOR shall maintain an inspection and maintenance log on each vehicle AND shall also provide an invoice at the completion.of each scheduled maintenance repair. The log and invoice shall contain at a minimum,but not be limited to, the following: (a) Starting date and time (b) Completion date and time (c) Billable labor hours (d) County Identification number of Apparatus serviced (e) Service performed (f) Parts used and cost (g) Name of service personnel (h) Vehicle mileage (i) Engine hours(if applicable) A copy of this log and invoice shall be supplied to the Fire Rescue Office within 30 days of the service. L. The Contractor shall respond to all original Emergency Field Repair Forms by emailing the invoice to the Logistics Support Services office with documentation of repairs made,parts used and any other miscellaneous information that is applicable (ex: Tires need to be changed). M. COMMUNICATION -CONTRACTOR shall maintain a telephone or paging device such that prompt notification of request for service is possible twenty-four (24) hours a day. The CONTRACTOR shall have two (2)hours to contact Monroe County Fire Rescue upon initial notification if reached by telephone or paging device and twelve (12) hours if contacted by email. N. RESPONSE TO SERVICE REQUEST- CONTRACTOR shall maintain itself in a state of readiness during normal working hours, 8:00 am—5:00pm Monday thru Friday, and shall respond to the location where emergency repairs are needed within twelve (12)hours of receiving a request. For repairs required after normal working hours, CONTRACTOR shall respond to the location where emergency repairs are needed within twenty-four(24)hours of receiving a request. Contractor must notify the Logistics Support Office in advance of vacations or potential lapses in service so other arrangements can be made for service coverage. 0. CERTIFICATION - CONTRACTOR shall provide evidence satisfactory to the COUNTY that they are an Emergency Vehicle Technician(EVT)certified as 3 Level III Master Ambulance Technician and Automotive Service Excellence (ASE)certified Master Medium/Heavy Truck Technician. P. QUALIFICATIONS OF MAINTENANCE PERSONNEL-All personnel performing maintenance,repairs, adjustments and related work on Monroe County equipment shall be a certified or experiences in the work to be performed. Personnel performing work who are not certified or experienced in such work shall be directly supervised (in person)by an individual with such certification. Q. INDEMNIFICATION - CONTRACTOR shall indemnify and hold the COUNTY and Monroe County harmless for any negligence on its part, or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees,claim costs, and as per "Attachment B". All property or equipment being directly maintained or repaired by CONTRACTOR shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the COUNTY. LOCATION OF WORK-This contract is for maintenance of Fire Rescue vehicles located throughout Monroe County. tl R. INSURANCE - During the term of this contract,the CONTRACTOR must keep in force and affect the insurance required by Attachments G. Attachment G is attached and incorporated into this contract. S. ADDITIONAL REQUIRED STATEMENTSNERIFICATIONS/AFFIDAVITS. Attached hereto in Attachments B, C, D,E and F are Non-Collusion Affidavit, Public Entity Crime Statement, Drug-Free Workplace Form, Conflict of Interest Clause, and Indemnification to Hold Harmless. T. PAYMENTS - Payments for semi-annual inspection,preventative maintenance and pump tests shall be made by the COUNTY within 30 days of the completion of the rendered services on each vehicle and proper invoicing by the CONTRACTOR. All payments will be made in accordance with the Florida Local Government Prompt Payment Act. All unscheduled maintenance and repair resulting from equipment failure or malfunction requiring service shall be billed by the CONTRACTOR at the applicable rates as specified in Section four, five and six of this AGREEMENT. The CONTRACTOR upon notification by the COUNTY of an equipment failure or malfunction requiring unscheduled maintenance shall, in a timely manner investigate the problem and provide to the COUNTY an estimate of the cost for repair and vehicle downtime. The CONTRACTOR upon receiving authorization to proceed from the COUNTY shall effectuate such repair; upon completion of same the CONTRACTOR shall notify the COUNTY of the outcome and actual cost. The COUNTY shall issue a separate purchase order for each occurrence of unscheduled maintenance and repair. 4 U. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. V. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly authorized representative. r .�1 BOARD OF GOVERN09g O F7r ;— •.• FI A AMBULANCE '- n OF MONROE COUNTY,FL- DISTRICT ry I .: a3 ATTEST: DANNY L. KOLHAGE, CLERK 'e M By: ByAw : ,- r, 071!N Deputy Clerk Mayor/Chairman_ MONK COUNTY . ATT ORNE APAVES--rTFN e ress esoet: CL AL ASSIS TOUNTY �TTORNEY Roy Khanna1033 Valencia Road KeyLargo, FL 33037 ya i ess signature Si�nUaf Respondent CN Print e {{and Title Date: I 1 Approved by MONROE COUNTY onrt. 11, Iie SUBMISSION PROPOSAL RESPONSE FORM Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles Respondents Name and Mailing Address: 14 Telephone and Fax Numbers: .5—I/,- - cr celrl-t^ All amounts must be written AND in number format.In case of a conflict between the amount in words and the amount in numbers,the amount in words shall control.Prices are to be inclusive of travel,mileage, etc. Hourly to for Scheduled Preventative Maintenance: J—b AL Charge for conducting ambulance and other vehicle inspections(with each preventative maintenance): Parts to be d Ze nj"I(E_ 1 jt� °/®over cos the Contractor I have included: • Proposal • Submission Response Form • Non Collusion Affidavit ✓ • Public Entity Crime Statement 77 • Lobbying and Conflict of Interest Clause Form • Drug Free Workplace Form ✓ • Indemnification and Hold Harmless • Local Preference Form (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposaL STATE (Si gnatureofte:isip—ondent) COUNTY OF LNZO Date PERSONAL W APPEA RED BEFORE ME,the undersigned authority, ti who,after first being sworn by me,(name of individual signing affixed his/her signature in the space provided above on this cpp day of kM 2010. My commission expires: NOTARY PUBLIC EUZA"EL KOURY Attachment A IN COMMIS"0 EE 04MI EXPIRM December 11.201{ BwoM TIVU NOWY Pubk W*MftM 25 NON-COLLUSION AFFIDAVIT I, V IN t+-►-k"r4 ,of the city of L r c according to law on my oath, and under penalty of perjury,depose and say that; 1) I am R-o Y Kt1 c4" +I rR- ,the respondent making the Proposal for the project described as follows: /ylAynT-,t+*?Lam,- e-%� Ciwrty Fi, c5c�e- tit"f3c +"ejes -, D a77. e-r- l /�� LDS RFP-PyD--1i - 3 5y-J nvA/Cl/ 2) The prices in this proposal have been arrived at independently without collusion,consultation,communication or agreement for the purpose of restricting competition,as to any matter relating to such prices with any other respondent or with any competitor; 3) Unless otherwise required by law,the prices which have been quoted in this proposal have not been knowingly disclosed by the respondent and will not knowingly be disclosed by the respondent prior to proposal opening,directly or indirectly,to any other respondent or to any competitor,and 4) No attempt has been made or will be made by the respondent to induce any other person,partnership or corporation to submit,or not to submit,a proposal for the purpose of restricting competition;and 5) The statements contained in this affidavit are true and correct,and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. STATE OF i�4 4 ignature of Respondent) 50 L e COUNTY OF _900909�_ ! .�- - ,�-y —/ G• Date PERSONALLY APPEARED BEFORE ME,the undersigned authority, V er who,after first being sworn by me,(name of individ 1 signing)affixed his/her signature in the space provided above on this day of_��C'.�Ja(�f,�2 ,20 /d EL MABE'M EL KOURY C iSS ion exp' ►AY COGU�i{5 M I EE 04=1 NO Y PUBLIC EXPIRES:De=1w 11,2014 eondea mu►ia.r R,eic uoe OMB-MCP FORM#l Attachment B 26 C x PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a proposal on a contract to provide any goods or services to a public entity, may not submit a proposal on a contract with a public entity for the construction or repair of a public building or public work,may not submit proposals on leases of real property to public entity, may not be awarded or perform work as a bidder,supplier,subbidder,or RESPONDENT under a contract with any public entity,and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." By executing this form, I ucknowledge that I/my company is in compliance with the above. STATE OF it* '+- (Sig ature of Respondent) S o L f COUNTY OF �`.���;C. 0 " I-C,— 1 V Date PERSONALLY APPEARED BEFORE ME,the undersigned authority, f who,after first being sworn by me,(name of individua signing)affixed his/her signature in the space provided above on this .« dayof ,20 / . f j My co mission expirre�s:. NOTARY PUBLIC B"MELKWW ty0%#MW gtEEWMi ,. EXPIRES:Oeoen+�ef 11.2At4 gp�lTruNofarli� � Attachment C 27 DRUG-FREE WORKPLACE FORM The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that: Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture,distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under proposal a copy of the statement specified in subsection(1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under proposal, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contcndre to, any violation of Chaptcr 893 (Florida Statutes)or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five(5)days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above require e espondents Signature j p 1.E O L-rx-ey— Dafe' OMB-MCP FORM#5 Attachment D 28 LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY,FLORIDA ETHICS CLAUSE warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 1.0-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County may, in its discretion,terminate this contract without liability and may also, in its discretion,deduct from the contract or purchase price,or otherwise recover,the full amount of any fee,commission,percentage,gift,or consideration paid to the former ounxy officer or employee. (Signature) 5oG-e- l✓u'n �''`�- Date: STATE OF fZv2t.PA COUNTY OF AV&)& - PERSONALLY APPEARED BEFORE ME,the undersigned authority, o &t4 who,after first being sworn by me,affixed hi er signature(name of individual signing)in the space provided above on this oW day of - a 20 /d . NOT AR"? BLI - My commission expires: am"9-lrom 'i WY 001AM SIM 1 ff NMI OMB-MCP FORM N4 --t Attachment E 29 MONROE COUNTY,FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADN 41STRATION MANUAL Indemnification and Hold Harmless for Other Bidders and Subbidders The Bidder covenants and agrees to indemnify and hold harmless Monroe Board of Governors for Fire and Ambulance District 1, its servants,agents and employees from any and all claims for bodily injury(including death),personal injury,and property damage(including property owned by Monroe County)and any other losses,damages, and expenses(inc uding attorney's fees)which arise out of, in connection with,or by reason of services provided by the Bidder or any of its Subbidder(s) in any tier, occasioned by the negligence,errors,or other wrongful act or omission of The Bidder or its Subbidders in any tier,their employees,or agents. In the event the completion of the project(to include the work of others) is delayed or suspended as a result of the Bidder's failure to purchase or maintain the required insurance,the Respondent shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars($10.00)of remuneration paid to the Respondent is for the indemnification provided for above. The extent of liability is in no way limited to, reduced,or Icsscned by the insurance requirements contained elsewhere within this agreement. Respondent's Signature 5c Le- Date TCS Attachment F 0 9 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND ROY E HANNA Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $300,000 Combined Single Limit(CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve(12)months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. l Attach e t C(1 of 4) 1 i n VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY,FLORIDA AND ROY KHANNA Recognizing that the work governed by this contract requires the use of vehicles,the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include,as a minimum,liability coverage for: • Owned,Non-Owned, and Hired Vehicles The minimum limits acceptable shall be: $100,000 Combined Single Limit(CSL) If split limits are provided,the minimum limits acceptable shall be: $ 50,000 per Person $100,000 per Occurrence $ 25,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 1 Attachment G(2 of 4) 32 WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY,FLORIDA AND ROY KHANNA Prior to the commencement of work governed by this contract,the Contractor shall obtain Workers'Compensation Insurance with limits sufficient to respond to Florida Statute 440. In addition,the Contractor shall obtain Employers'Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease,each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor as an authorized self-insurer,the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance,providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. 1 Attachment G(3 of 4) 33 MONROE COUNTY, FLORIDA Request For Waiver of Insurance Requirements It is requested that the insurance requirements,as specificd in the County's Schedule of Insurance Requirements,be waived or modified on the following contract. 77 Contrac K tor: o R FP-P-S -35 yf— Contract for: Address of Contractor: -7 Phone: 30 Scope ul'Work: R=wn lbr Waiver: Policies Waiver ti 0 will apply to: th 5 Signature ul'Con tructor: V Approved Not Approved Risk Management Date County Adminisuutur appeal: Approved: Not Approved: Date: Board orCuunly Corrunissioncrs appeal: Approved: Not Approved: Meeting Date: 411achment G (4 ul 4) 34 DATE(M 0 ) 1 10/201 0r IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ISURE (S), AUTHORIZED I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseent(s). PRODUCER A J MILLERINSURANCE 1 333 FAX Na ( 514 , Military it #2 ADDRESS jw Rjohill i s n . W Palm Beach, FL 33409 -PRODUCER T M RIPr®l , INBURERMI A OROINO COVERAGE NAICS INSURED Y KHANNA INSURER A f1e•_. _ O1 3117 m, I CAROL AVE ky to Ftj'11°`IT PALM SPRINGS, FL 33461 - 1 INSURER D 1)641-2360 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER, EVISIN NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE 1NDR wVO I POLICY NUMBER MMIW1OrfffYYY (MWO LIMITS GENERAL LIABILITY rr EACH OCCURRENCE S 1 1000,000 COMMERCIAL GENE L L+IABILITY I PREM15E5T�Ea 0 3 50,000 1 fCLAIMS I OCCUR I 1 MEO EXP(AnV we person) f , Y — �1 / /1 `3.2/ /11 PERSONAL a ADV INJURY 1 1. 12010 { GENERAL AGGREGATE 1 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-CO PrOP G 1 1 r 0 , �01 1L POLICY 11 PRO. LOCI, 1 1 f AUTOMOBILE LIABILITY (OMBInISINGLE LIMIT 3 1 0CI0 000 ; IANYAUTO I' I ' � BODILY INJURY(Per person) �S • i— ALL OWNED AUTOS ; BODILY INJURY(Per acudonf)I f t { (I scHEoulEo AUTOS ` 6N ® /1 / ®1 I I PROPERTY DAMAGE S �g HIRED AUTOS (Par acadont) V NON-OWNED AUTOS I 1 s UMBRECIA L OCCUR 1! EACN CURRENCE f EXCESS LIAR CLAIMS- DE AGGRE TE 1 DEDUCTIBLE f RETENTION 1 WORKERS COMPENSATION 1 WC TO RYTA T R AND EMPLOYERS"LIABILITY YrR ! AM PROPMETORIPARtNERIEXECUTIVE EL EACH ACCIDENT (S OFFICER[MEMDER EXCLUD907 I NI A I dNay 0 NN) 1 ! ' L DISEASE•EA EMPLOYEE,1 it er D SCRiPTION OF OPERATIONS tolow I ` E L DISEASE•POLICY LIMIT S � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aftwh ACORO 101 Addihonal Remarks Sthedu0 f twwa Space m roquued) COUNTYMONTOE I ILISTED ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION I MONROE COUNTY BOARD OF COUNTY I � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COMMISSIONERS I THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED I ISK MANAGEMENT I ACCORDANCE WITH HE POLICY PROVISIONS 1100 SIMONTON AUTHORil REPRESENTA E KEY WEST, FL 33040 J FAX: 305-269-6061 t. �.. L (/�.`��) (0 198-2 ACOD CORPORATION All nghls reserved ' CD25(2 9t09) The ACORD name and logo are registered marks of ACOR royrkhannacs.co DATE(MM/DDIYYYY) ACOORDi CERTIFICATE OF GARAGE INSURANCE 1/9/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONACNAME; T Deborah Howard Al24072 Insurance Capital Management LLC PHONE 561-223-2199 ac N®:561-209-5581 Suite 315-9 ADDRESS:1035 S.State Road 7 E-MAIL is llcl3 ahoo.co Suit Wellington,FL 33414 INSURER S AFFORDING COVERAGE NAIc a INSURERA:Colony Insurance Company INSURED INSURER B: Roy Khanna INsuRERc: 3117 Carol Avenue INSURER D: Palm Springs,FL 33461 INSURER E INSURER F: COVERAGES PROD I CUSTOMER ID: CERTIFICATE#: REVISION#: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Y EXP ILTR TYPE OF INSURANCE INSO ® POLICY NUMBER MLISUBR M/DDY MM/DDf LIMITS LTR GARAGE LIABILITY AUTO ONLY(Ea accident) ALL OWNED HIRED AUTOS $ 1,000,000. A AUTOS ONLY X GP8177220 1/9/2014 01/09/2015 NON-OWNED AUTOS OTHER THAN EA ACCIDENT $ 1 000 000. USED IN GARAGE BUSINESS 1/ Sealer Service Liability AUTO ONLY AGGREGATE s 2,000,000. GPERILS ARAGE KEEPERS LIABILITY / COMP/ LOC $ 180,000. V/ LEGAL LIABILITY V SPECIFIED LOC $ A DIRECT BASIS P8177220 01/09/201401/09/2015 ✓ COLLISION LOC s 180,000. PRIMARY EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED S CLAIMS-MADE 0 OCCUR PREMISES Ea occurrence $ MED EXP Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY 0 PRO' LOC JECT PRODUCTS-COMP/OP AGG $ OTHER: $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y/N N/A (Mandatory in NH) ElE.L.DISEASE-EA EMPLOYE $ If as,describe under REMARKS belay I I I E.L.DISEASE-POLICY LIMIT 1$ REMARKS(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Monroe County Board of County Commissioners is listed as an additional insured as indicated above with an"x" CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners An: Rick Management SHOULD ANY of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. Key West FL 33040 Fax 305-289-6061 AUTHORIZED REPRESENTATIVE Fax 305-292-447 A124072 -4&g LrALP� ©2010,2014 ACORD CORPORATION. All rights reserved. ACORD 30(2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software.www.FormsBoss.com;0 Impressive Publishing 800-208-1977 i LOCAL PREFERENCE FORM Vendors claiming a local preference according to Ordinance 023-2009 must complete this form. Name of Bidder/Responder L"y ®t 3 K g► h r-ll" Date: 1.Dom the vendor have a valid receipt Ibr the business tax paid to the Monroe County Tax Collector dated at lest one year prior to the notice or request Ibr bid or proposal? t'-4 (Please furnish copy.) 2.Does the vendor have a physical business address located within Monroe County from which the vendor operates or perlbrms business on it day to day basis that is a substantial component of the goods or services beingoffered to Monroe County?. _ 7G Y .�L...r.._. . Lill Address: /d 3�_�'�-LE'�s1 G,N �'� /`may Lr-t K�; FL- 3 30 3 7 Telephone Number:__, C _ 13.Does the vendor/prime contractor intend to subcontract 50%or more of the goods,services or construction to local businesses meting tine criteria above as to licensing and location? AdO If yes,please provide: 1.Copy of Reccipt of the business lax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or rceluest for bid or proposal. 2.Subcontractor Address within Monroe County from which the subcontractor operates: Tel.Number Print Name: I C Sign ure and'l itic of Authorized Signatory Ibr Bidder/Responder S`'L•C C►`�✓^ �Y' STA"TF(W _� i COUNTY Ole On this _ day of�_;:' 20 txabrc me, the undersigned notary public, personally appeared known to me to be the person whose name is subscribed above or who produded _ it% identification, and acknowledged that he/she is the person who executed the strove Local Prcl'crcncc form for the purposes therein contained. Notary Public Print Nant me w•� My commission expire:_ Seal Alluchmenl/1 MY �. 2Iy01 �� ' • • ttl l4 6 y NftyAft f A� f I t CURRENT MONROE COUNTY FIRE RESCUE AMBULANCES and OTHER VEHICLES Radio d VEHICLE Prime or Call LOCATION YEA EI MODEL COUNTY ID Backu i n 2002 FORD STOCK ISLAND AMBULANCE 1 FDXF46F22ED14878 1416-215 Prime R-8 2006 STERLING BIG COPPITT AMBULANCE 2FZACFCS76AV92511 1416-5098 Prime R-9 2001 FORD BIG COPPITT AMBULANCE 1 FDXF46F81 EC33365 1416-208 Backup R-109 1994 FORD REHAB Rehab- BIG COPPITT UNIT 1FDLF476REA52322 1417-159 Backup 9 2010 FORD PICK UP BIG COPPITT TRUCK 1 FDA5HR2AE04654 6819 MCI MCI MCI BIG COPPITT 2005 MCI TRAILER 1WC200J2X53052439 5621 MCI Trailer Trailer 2008 HORTON CUDJOE AMBULANCE 3HTMNAA68N698467 6507 Prime R-11 2006 STERLING BIG PINE AMBULANCE 2FZACFCS37AX62073 1416-5806 Prime R-13 TRAINING 1997 FORD RESCUE 1 FDXF46F61 EC33364 1416-059 Back up R-39 2009 FORD CONCH KEY AMBULANCE IFDXE45P79DA90438 1416-6845 Prime R-17 2001 FORD CONCH KEY AMBULANCE 1 FDXF46F41 EC33363 1416-206 Backup R-117 2009 FORD TAVERNIER AMBULANCE 1FDE45P19DA83131 6813 Prime R-22 1998 FORD TAVERNIER AMBULANCE 1FDXF46F9XEB99283 1416-120 Backup R122 1992 FORD REHAB Rehab- TAVERNIER UNIT 1 FDFL47F2SEA30339 4295 Backup 22 Attachment I I4 SUBMISSION PROPOSAL RESPONSE FORM Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles Respondents Name and Mailing Address: ko y Telephone and Fax Numbers: a S"- Y ell"-A All amounts must be written AND in number format.In case of a conflict between the amount in words and the amount in numbers,the amount in words shall control.Prices are to be inclusive of travel, mileage,etc. Hourly Rate for Scheduled Preventative Maintenance: oy Charge for conducting ambulance and other vehicle inspections(with each preventative maintenance): Paar``ts to be marked u-p_by: o5,>I %over bbsttoto the Contractor I have included: o Proposal o Submission Response Form _✓ o Non Collusion Affidavit o Public Entity Crime Statement o Lobbying and Conflict of Interest Clause Form o Drug Free Workplace Form o Indemnification and Hold Harmless A o Local Preference Form t/ (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal, STATE OF r4-9- i'TXf" S tore of Respondent) 501COUNTY OF A)P I Zd 415 a -';L0 Date PERSONALI,hY APPEARED BEFORE ME,the undersigned authority, 0 who,after first being sworn by me,(name of individual signing)affixed si�ature in the space provided above on this ag day of-iD9U-,w3 e2— ,201a. My commission expires: NOTARY PUBLIC EUMBETH a'KOURY j WOOMSION/EE 0=1 Attachment A EXPIRES:DOMTA r 11.2014 so�+e�a Thu N**y Pu*Ueomw 1 m 25 b G r� R �o•